Background
Both one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) and two-stage endoscopic retrograde cholangiopancreatography (ERCP) followed by ...sequential LC approaches are effective treatment for concomitant common bile duct (CBD) stones and gallstone. Although many studies compared one-stage with two-stage surgical approach for cholecysto-choledocholithiasis, there are very few studies compared the two management strategies for acute cholecystitis (AC) associated with CBD stones.
Methods
Between January 2014 and December 2019, patients with concomitant AC and CBD stones proposed to early surgery were retrospectively studied. The patients were scheduled to undergo either the one-stage LCBDE and LC (LCBDE+LC) were undertaken at the same operation or two-stage preoperative ERCP for CBD stone clearance was followed by LC 1–3 days later (pre-ERCP+LC) procedure. The success rate of complete stone clearance, procedure-related complication, hospital stay, hospitalization charges and later biliary complications were compared between the two groups.
Results
Sixty patients were included in the study, 28 in the one-stage group and 32 in the two-stage group. There was no significant difference in the success rate of complete stone clearance (96.4% vs. 93.8%,
P
= 1.000), complication rate (10.7% vs. 9.4%,
P
= 1.000), incidence of pancreatitis (0 vs. 6.3%,
P
= 0.494) or length of hospital stay (12 ± 5 vs. 11 ± 4 days,
P
= 0.393) between the two groups.
Conclusion
For patients with concomitant AC and choledocholithiasis proposed to early surgery, both the one-stage (LCBDE+LC) and two-stage (pre-ERCP+LC) approaches were acceptable and broadly comparable in achieving clearance of CBD stones.
Background
Recently, randomized controlled trials (RCTs) have indicated that bariatric surgery in nonseverely obese patients with a body mass index (BMI) less than 35 kg/m
2
might be even superior to ...medical therapy with regard to type 2 diabetes mellitus (T2DM) remission, but the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) in nonseverely obese patients has not been conclusively determined. The objective of this study is to compare LRYGB versus LSG for T2DM in nonseverely obese patients.
Methods
A meta-analysis identifying RCTs evaluating LRYGB versus LSG for T2DM in nonseverely obese patients was conducted. The primary outcome was T2DM remission. Additional analyses comprised percent excess weight loss (%EWL), BMI, waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum lipid level, medication use, quality of life, and adverse events.
Results
Four RCTs concerning total 296 patients were included. T2DM remission rate and %EWL were of no difference between the two bariatric procedures. LRYGB was associated with lower BMI, waist circumference, low-density lipoprotein, and higher high-density lipoprotein than LSG. However, HbA1c, FPG, total cholesterol, and triglyceride were not significantly different between the two surgical groups. The medication use and quality of life were improved in both two groups. The gastroesophageal reflux diseases of LRYGB group were less than that of LSG group. Dumping syndromes were noted more frequently in the LRYGB group.
Conclusions
Both LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
This meta-analysis compares the perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to those of open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumors.
LPD has ...been increasingly applied in the treatment of pancreatic and periampullary tumors. However, the perioperative outcomes of LPD versus OPD are still controversial.
PubMed, Web of Science, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) comparing LPD versus OPD for pancreatic and periampullary tumors. The main outcomes were mortality, morbidity, serious complications, and hospital stay. The secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by the Cochrane risk-of-bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Non-randomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).
Four RCTs and 35 NRCTs concerning a total of 40,230 patients (4,262 LPD and 35,968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91,
= 0.35), serious complications (OR 0.97,
= 0.74), POPF (OR 0.93,
= 0.29), PPH (OR 1.10,
= 0.42), BL (OR 1.28,
= 0.22), harvested lymph nodes (MD 0.66,
= 0.09), reoperation (OR 1.10,
= 0.41), and readmission (OR 0.95,
= 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 min,
< 0.00001), whereas overall morbidity (OR 0.80,
< 0.00001), hospital stay (MD -2.32 days,
< 0.00001), blood loss (MD -173.84 ml,
< 0.00001), transfusion (OR 0.62,
= 0.0002), and DGE (OR 0.78,
= 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25,
= 0.001).
LPD is associated with non-inferior short-term surgical outcomes and oncologic adequacy compared to OPD when performed by experienced surgeons at large centers. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.
PROSPERO, identifier CRD42022338832.
Tokyo Guidelines 2018 (TG18) proposed laparoscopic cholecystectomy (LC) for acute calculus cholecystitis (ACC) irrespective of the duration of symptoms. This retrospective study assessed the impact ...of utility of TG18 in early LC for ACC.
From 2018 to 2020, 66 patients with mild (grade I) and moderate (grade II) ACC who underwent early surgery were studied. Subgroup analyses were based on timing of surgery and operation time.
A total of 32 and 34 patients were operated within and beyond 7 days since ACC onset. More patients with grade II ACC were in the beyond 7 days group (
< 0.05). More patients with enlarged gallbladder were in the within 7 days group (
< 0.05). The duration of symptoms to admission, symptoms to LC, and operation time were longer in the beyond 7 days group (
< 0.05). There were no significant differences regarding intraoperative blood loss, conversion to bail-out procedures, complication rate, hospital stay, and cost between the two groups (
> 0.05). Longer operation time was significantly associated with duration of symptoms to admission, symptoms to LC, and conversion to laparoscopic subtotal cholecystectomy (LSC) (
< 0.05).
In a subset of carefully selected patients, applying TG18 in early LC for mild and moderate ACC results in acceptable clinical outcomes. Standardized safe steps and conversion to LSC in difficult cases are important.
Increasing use of organophosphorus flame retardants (OPFRs) has aroused great concern to their uncertain environment risk, especially to human health risk. In our study, hepatotoxicity screening of ...six aryl-OPFRs, potential hepatotoxicity mechanism of 2-ethylhexyldiphenyl phosphate (EHDPP) using RNA-sequencing and its metabolites were investigated in human hepatocytes (L02). The toxicity results demonstrated that EHDPP should be prioritized for further research with the highest toxicity. Further RNA-seq results through GO and KEGG enrichment analysis indicated that exposure to 10 mg/L of EHDPP significantly affected energy homeostasis, endoplasmic reticulum (ER) stress, apoptosis, cell cycle, and inflammation response in cells. The top 12 hub genes were validated by RT-qPCR and conformed to be mainly related to glycolysis and ER stress, followed by cell cycle and inflammation response. Western blot, apoptosis detection, glycolysis stress test, and cell cycle analysis were further performed to verify the above main pathways. Additionally, it was found in the metabolism experiment that detoxification of EHDPP by phase I and phase II metabolism in cells wasn’t significant until 48 h with a metabolic rate of 6.12%. EHDPP was stable and still dominated the induction of toxicity. Overall, this study provided valuable information regarding the toxicity and potential metabolism pathway of EHDPP.
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•EHDPP was the most toxic one among the six aryl-OPFRs towards human hepatocytes.•Energy homeostasis, ER stress, apoptosis, cell cycle and inflammation response were affected in EHDPP-induced toxicity.•EHDPP was stable in human hepatocytes.•The potential metabolism pathway of EHDPP included phase I and phase II metabolism.
The concept of triboelectric nanogenerator (TENG)-based fibrous air filters, in which the electroactive fibers are ready to enhance the electrostatic adsorption by sustainable energy harvesting, is ...appealing for long-term respiratory protection and in vivo real-time monitoring. This effort discloses a self-reinforcing electroactivity strategy to confer extreme alignment and refinement of the electrospun poly(lactic acid) (PLA) nanofibers, significantly facilitating formation of electroactive phases (i.e., β-phase and highly aligned chains and dipoles) and promotion of polarization and electret properties. It endowed the PLA nanofibrous membranes (NFMs) with largely increased surface potential and filtration performance, as exemplified by efficient removal of PM0.3 and PM2.5 (90.68 and 99.82%, respectively) even at the highest airflow capacity of 85 L/min. With high electroactivity and a well-controlled morphology, the PLA NFMs exhibited superior TENG properties triggered by regular respiratory vibrations, enabling 9.21-fold increase of surface potential (−1.43 kV) and nearly 68% increase of PM0.3 capturing (94.3%) compared to those of conventional PLA membranes. The remarkable TENG mechanisms were examined to elaborately monitor the personal respiration characteristics, particularly those triggered large and rapid variations of output voltages like coughing and tachypnea. Featuring desirable biocompatibility and degradability, the self-powered PLA NFMs permit promising applications in the fabrication of ecofriendly air filters toward high-performance purification and intelligent monitoring.
Carbamazepine (CBZ) is a widely used anticonvulsant drug that has been detected in aquatic environments. This study investigated the toxicity of its by-products (CBZ-BPs), which may surpass CBZ. ...Unlike the previous studies, this study offered a more systematic approach to identifying toxic BPs and inferring degradation pathways. Furthermore, quadrupole time-of-flight (QTOF) and density functional theory (DFT) calculations were employed to analyze CBZ-BP structures and degradation pathways. Evaluation of total organic carbon (TOC) and total nitrogen (TN) mineralization rates, revealed carbon (C) greater susceptibility to mineralization compared with nitrogen (N). Furthermore, three rules were established for CBZ decarbonization and N removal during degradation, observing the transformation of aromatic compounds into aliphatic hydrocarbons and stable N-containing organic matter over time. Five potentially highly toxic BPs were screened from 14 identified BPs, with toxicity predictions guiding the selection of commercial standards for quantification and true toxicity testing. Additionally, BP207 emerged as the most toxic, supported by the predictive toxicity accumulation model (PTAM). Notably, highly toxic BPs feature an acridine structure, indicating its significant contribution to toxicity. These findings offered valuable insights into the degradation mechanisms of emerging contaminants and the biosafety of aquatic environments during deep oxidation.
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•The rules of CBZ decarbonization and nitrogen removal during UV/H2O2 were deduced.•Key by-products were quantified on concentration and toxicity.•Acridine structure was the main toxic contributor.•Carbon was more likely to be mineralized than nitrogen during degradation.•The degradation pathways were obtained by combing N-transformation and DFT.
Despite great potential in fabrication of biodegradable protective membranes by electrospinning of poly(lactic acid) (PLA) nanofibers, it is still thwarted by smooth surfaces and poor electroactivity ...that challenge the promotion of electret properties and long-term air filtration performance. Here, a microwave-assisted synthetic method was used to customize dielectric TiO2 nanocrystals of ultrasmall and uniform dimensions (∼30 nm), which were homogeneously embedded at beaded PLA nanofibers (PLA@TiO2, diameter of around 280 nm) by the combined “electrospinning-electrospray” approach. With small amounts of TiO2 (2, 4 and 6 wt%), the nanopatterned PLA@TiO2 nanofibrous membranes (NFMs) were characterized by largely increased dielectric constants (nearly 1.9), surface potential (up to 1.63 kV) and triboelectric properties (output voltage of 12.2 V). Arising from the improved electroactivity and self-charging mechanisms, the nanopatterned PLA@TiO2 NFMs exhibited remarkable PM0.3 filtration properties (97.9 %, 254.6 Pa) even at the highest airflow rate of 85 L/min, surpassing those of pure PLA membranes (86.2 %, 483.7 Pa). This was moreover accompanied by inhibition rates of 100 % against both E. coli and S. aureus, as well as excellent UV-blocking properties (UPF as high as 3.8, TUVA of 50.9 % and TUVB of 20.1 %). The breathable and electroactive nanopatterned PLA NFMs permit promising applications in multifunctional protective membranes toward excellent UV shielding and high-efficiency removal of both PMs and pathogens.
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•Dielectric TiO2 nanocrystals of ultrasmall and uniform size were customized by a microwave-assisted approach.•A combined “electrospinning-electrospray” strategy was proposed to embed TiO2 nanoparticles at beaded poly (lactic acid) (PLA) nanofibers (PLA@TiO2).•Electret and tribo-output properties were largely promoted for the nanopatterned electroactive PLA@TiO2 nanofibrous membranes (NFMs).•The air-permeable and antibacterial PLA@TiO2 NFMs exhibited remarkable PM0.3 filtration (97.9 %, 85 L/min) and UV-shielding performance (UPF of 3.8).
Biodegradable polylactic acid (PLA) nanofibrous membranes (NFMs) hold great potential to address the increasing airborne particulate matter (PM) and dramatic accumulation of plastic/microplastic ...pollution. However, the field of PLA NFM-based filters is still in its infancy, frequently dwarfed by the bottlenecks regarding relatively low surface activity, poor electroactivity, and insufficient PM capturing mechanisms. This effort discloses a microwave-assisted approach to minute-level synthesis of dielectric ZIF-8 nanocrystals with high specific surface area (over 1012 m2/g) and ultrasmall size (∼240 nm), which were intimately anchored onto PLA nanofibers (PLA@ZIF-8) by a combined “electrospinning–electrospray” strategy. This endowed the PLA@ZIF-8 NFMs with largely increased electroactivity in terms of elevated dielectric coefficient (an increase of 202%), surface potential (up to 5.8 kV), and triboelectric properties (output voltage of 30.8 V at 10 N, 0.5 Hz). Given the profound control over morphology and electroactivity, the PLA@ZIF-8 NFMs exhibited efficient filtration of PM0.3 (97.1%, 85 L/min) with a decreased air resistance (592.5 Pa), surpassing that of the pure PLA counterpart (88.4%, 650.9 Pa). This was essentially ascribed to realization of multiple filtration mechanisms for PLA@ZIF-8 NFMs, including enhanced physical interception, polar interactions, and electrostatic adsorption, and the unique self-charging function triggered by airflow vibrations. Moreover, perfect antibacterial performance was achieved for PLA@ZIF-8, showing ultrahigh inhibition rates of 99.9 and 100% against E. coli and S. aureus, respectively. The proposed hierarchical structuring strategy, offering the multifunction integration unattainable with conventional methods, may facilitate the development of biodegradable long-term air filters.
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•Dielectric CNT@ZIF-8 nanohybrids of high surface activity were customized by a microwave-assisted approach.•Poly(lactic acid) (PLA) nanofibers were decorated by the nanohybrids via a ...combined “electrospinning‒electrospray” strategy.•The electroactive nanofibers were characterized by largely promoted surface potential and tribo-output properties.•The electroactive nanofibers exhibited a combination of remarkable PM capturing, self-sterilization and photothermal properties.
Biodegradable poly (lactic acid) (PLA) nanofibrous membranes (NFMs) are appealing to address the increasing air pollution and outbreak of epidemic diseases, as well as the drastic accumulation of plastic and microplastic pollutions. Central to the development of high-performance PLA membrane filters are the promotion of electroactivity, polarization and electret properties, which has been a roadblock toward efficient capturing of airborne particulate matters (PMs) and bacterial pathogens. Herein, we proposed a microwave-assisted synthetic approach to enable direct growth of ZIF-8 nanocrystals at carbon nanotubes (CNT@ZIF-8 nanohybrids), which were spontaneously embedded into PLA nanofibers by a combined electrospinning–electrospray technology. With uniform and affinitive anchoring of CNT@ZIF-8 (8, 10 and 12 wt%), the PLA NFMs were characterized by largely increased surface potential (up to 1.78 kV), nearly doubled dielectric constant, and excellent triboelectric properties (output voltage of 12.7 V at 10 N, 0.5 Hz). The highly electroactive PLA/CNT@ZIF-8 NFMs exhibited excellent air filtration properties (98.7 % and 99.8 % removal of PM0.3 and PM2.5, 206.9 Pa) even at the highest airflow capacity of 85 L/min, in clear contrast to the pure PLA counterpart (81.2 % and 84.1 %, 465.2 Pa). This was accompanied by 100 % perfect inhibition of both E. coli and S. aureus regardless of the CNT@ZIF-8 loadings, arising mainly from the elevated surface activity, facilitated generation of reactive oxygen species, and gradual release of zinc ions. Moreover, remarkable photothermal properties were demonstrated by temperature elevation of nearly 16 °C under near-infrared irradiation for only 20 s. The proposed methodology affords an exceptional combination of excellent air filtration, self-sterilization and photothermal properties, which may motivate development of ecofriendly and functional protective membranes for personal healthcare.
